View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0662	ICR Reference No: 202501-0960-003
Status: Active	Previous ICR Reference No: 202404-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Medical Source Statement of Ability to Do Work-Related Activities
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/27/2025
	Date Received in OIRA: 01/16/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	11/30/2027	11/30/2027
Responses	343,600	0	300,000
Time Burden (Hours)	78,633	0	75,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	343,600	300,000	43,600
Annual Time Burden (Hours)	78,633	75,000	3,633
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We are increasing the burden for this ICR to include the burdens associated with the CFR citations 20 CFR 404.1740(b)(5)&(6), and 416.1540 (b)(5)&(6). These citations were previously listed under OMB Number 0960-0804 (the rule-related ICR); however, as we are discontinuing that ICR, we are including the burden here (see the Justification for the Non-Substantive Changes document for more information).

Annual Cost to Federal Government: $336,387

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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